6 Tips Towards Choosing an Antidepressant

Learn the steps you should take when searching for the right drug

With more than 30 antidepressants on the market, finding the right one is definitely a process. Recently, research published in the medical journal The Lancet indicated that sertraline (Zoloft) and escitalopram (Lexapro) may be best for treating depression without causing intolerable side effects. But that doesn't mean these drugs are right for everybody.

"I've conducted clinical trials, and we generally can't test medication on people who have more than one condition—say, depression and anxiety or an eating disorder—because it will be too difficult to determine what the results mean for a wide population," says Terry Eagan, MD, a psychopharmacologist and medical director of the Moonview Sanctuary outpatient clinic in Santa Monica, California. "But in reality, very few patients suffer from just one problem. That's why picking a medication has to be individualized."

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1. Review all your symptoms Depression often means more than sadness: People who are depressed may also have trouble sleeping, feel lethargic, and have aches and pains. Drugs like Cymbalta can relieve chronic pain, for example. Some SSRIs, like Paxil, work well to treat panic attacks and obsessive-compulsive disorder, which can accompany depression. Your doctor may also consider his experience treating similar patients (if other 30-something women who have anxiety along with depression have responded well to a particular drug, you might, too).

2. Take your family history into account Because you share a similar genetic makeup, you may do well on a certain medication if you already know that your mother, sister or other close family member responded positively to it.

3. Discuss side effects up front All drugs have the potential to cause
side effects, but some antidepressants are more apt to cause particular ones. Tell your doctor which side effects you most want to avoid so she can take that into consideration. For example, Wellbutrin is less likely to cause loss of libido or weight gain than some other drugs.

4. Be patient Most antidepressants take up to two months to improve mood, but some work as quickly as two weeks. Often, side effects (like nausea, fatigue and irritability) kick in right away, but subside within a week or so.

5. Expect some trial and error You may feel great on the first medication your doctor prescribes, but it's not unusual to try a few different drugs (or a combination) before finding the right one. "If a patient doesn't feel better within eight weeks, I might try another antidepressant," says Dr. Clayton. "Or, if certain side effects are really interfering with her life—she may feel exhausted or can't sleep well—I might add a stimulant or a sleep aid, to balance it out. And if there's still no improvement in a few weeks, then I probably would add another drug in a different class." Add-on options include Abilify, Buspar and lithium, which help stabilize mood and minimize anxiety. "There really is no formula. It's a lot of tinkering."

6. Keep communicating with your doctor If you're seeing a mental health practitioner for regular therapy sessions, she can monitor your progress. But if you're getting antidepressants from your internist or family care doctor (as many people do), ask how often you should check in with her (initially, probably every two weeks).